1. Field of the Invention
The present invention relates to surgical procedures, in general. More particularly, the present invention relates to vasectomies.
2. Description of the Related Art
Birth control measures that are currently being used are considered pre-conceptive, because each method is directed toward the prevention of the union of the spermatozoa and the ovum. The exception is the use of intra-uterine devices that prevent the implantation of the fertilized ovum. Other mechanical devices such as condoms and diaphragms are pre-conceptive in their function and have been used successfully for many years. Hormonal manipulation in the female can prevent ovulation and has been used extensively over the past forty years.
The major advantage of mechanical devices and pharmacologically controlled menses relates to the temporary suspension of normal conception. No permanent sterility is produced, and pregnancy can be planned. The disadvantages involve varying degrees of effectiveness, the need for regular compliance, and the occasional complications associated with exogenous hormone ingestion.
The surgical procedures that remove the germ cell organs of reproduction, bilateral orchiectomies in the male and bilateral oophorectomies in the female, have never been considered as reasonable birth control measures because of the extensiveness of the surgical procedures and the sudden hormone withdrawal. Hysterectomies, the removal of the uterus, are similarly considered a radical approach to birth control. The surgical approach to birth control has focused primarily on the disruption or occlusion of the tubules through which the sperm and the ovum pass. Tubal ligations in the female require an opening into the peritoneal cavity and use of a general or regional anesthetic in a hospital environment. Vasectomies in the male utilize a direct approach through the scrotum and can be effected with a local anesthetic in a physicians office.
Ligation of these ducts--oviducts in the female and vas deferens in the male--is very effective in preventing pregnancy. Although both procedures may be reversed, they involve very complicated and specialized surgical procedures that are often not successful in reestablishing the ducts. Patients undergoing these procedures must realize that the inducted sterility is often irreversible.
Ideally a vasectomy is an outpatient procedure that is quickly completed with minimal discomfort for the patient. He should then immediately be capable of resuming his normal activities. The majority of cases have this degree of successful results and minimal aftereffects. However, in a significant number of instances, prolonged exploration and manipulation accompanied by excessive discomfort both intraoperatively and postoperatively can make the results less than desirable.
Current vasectomy procedures involve the injection of a local anesthetic into the scrotal skin and then into the area surrounding the vas deferens. One or two incisions are then made and the vas is dissected, free to be ligated and divided. The scrotal openings then may or may not be closed with a suture. The manner in which the tissue is handled determines the amount of postoperative swelling and subsequent pain. Consideration of less than desirable results focuses attention on two important points. First, scrotal tissue is elastic and does not provide the benefits of tamponade found in many other parts of the body. In less compliant skin and soft tissue, tight closure of the incision minimizes postoperative bleeding and swelling. The scrotal skin and soft tissue offer little pressure to slow the loss of blood and fluid. Besides causing discomfort, the healing process is slowed because of the prolonged time required to reabsorb these fluids and cells, increasing the opportunity for bacterial colonization.
Another concern for the surgeon is the elusiveness of the vas deferens. This structure cannot be seen until the later stages of the procedure and must be identified by palpation. Once identified and delivered up to the scrotal opening, it must be held in place by some means of fixation. Even a momentary release of the vas allows it to immediately return to within the spermatic cord, from which it must again be extricated. The injection of a local anesthetic into the scrotal skin and the area surrounding the vas makes palpation of the structure difficult. Loss of fixation of the vas results in the need for increased dissection and manipulation causes increased bleeding and swelling.